Healthcare Provider Details

I. General information

NPI: 1013865898
Provider Name (Legal Business Name): JACQUELYN BUSH LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/18/2026
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

807A HOLCOMB BLVD
OCEAN SPRINGS MS
39564-3943
US

IV. Provider business mailing address

807A HOLCOMB BLVD
OCEAN SPRINGS MS
39564-3943
US

V. Phone/Fax

Practice location:
  • Phone: 775-340-9918
  • Fax:
Mailing address:
  • Phone: 775-340-9918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number2306
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: